by Rachel Shepherd, specialist, Informatics, APHL

The public health system serves as the backbone to our nation’s health and safety; there is nothing more collectively critical than making sure we are prepared to respond to threats. When a public health crisis like COVID-19 strikes, laboratories need to get mechanisms in place fast to test for a new pathogen. But there’s another, equally important side to that story. Without the technical infrastructure to send and receive data, and without agreed-upon language to communicate information, there could be no comprehensive response or strategy. In other words, you can build a car to get from Point A to Point B, but you won’t get very far if there are no roads. This is a story about roads.

In 2008, APHL built the APHL Informatics Messaging Services (AIMS) Platform, a messaging service for public health laboratories and agencies to transmit their influenza results to the US Centers for Disease Control and Prevention (CDC) for surveillance. Over time, AIMS went from having a handful of laboratories signed on to establishing connections with every state in the country, making, for the first time in history, near real-time national flu surveillance possible.

Today, most of the nation’s public health network—more than 200 public health laboratories and agencies, clinical and commercial labs, hospitals and medical providers, and federal agencies—uses AIMS to exchange critical health data, sending more than 25 million messages per month. AIMS now serves as a “super highway” on which testing data for several major public health initiatives flow, providing the means for national surveillance. While its functionality continues to expand, at its core AIMS ensures that important data travel fast into the right hands so that it can be actionable when it matters most.

When cases of COVID-19 began cropping up in the US, public health laboratories began getting testing up and running successfully. The public heard about assays not working, testing backlogs, overwhelmed staff, and reagent shortages. What the public didn’t hear about were the crises averted. Amidst all of the pandemic chaos, there has been at least one major positive: we already had a national data messaging platform that connects all of public health. No infrastructure had to be built; it’s been in place and growing since 2008.

When public health entities connect to AIMS, they enable faster transmission of a higher volume of data for surveillance or trend analysis. When information is exchanged through AIMS, what used to take days now takes minutes, and time saved—whether in a pandemic or in the routing and sharing of test orders and results—translates to lives saved. Doctors can make better informed decisions about patient-care when they have timely access to test results, and epidemiologists can analyze data to identify emergent threats before they become crises.

In addition to transporting data, AIMS also has portal services that automatically transform and translate data to different message formats and standards; in other words, users are able to communicate through AIMS, even if they are speaking different languages. AIMS converts messages and makes them readable to the receiver. Because of the sensitive nature of the data that flows through AIMS, AIMS takes security seriously and meets some of the most stringent security standards in the country.

AIMS also allows multiple users to take advantage of shared resources—for instance, laboratories can maintain one route on AIMS for all of their trading partners rather than having to establish and maintain an individual route with each. This is a major benefit to AIMS users. Typically, each laboratory would have to set up a connection with every entity with whom they exchange data—clinical laboratories, hospitals, public health agencies. When laboratories or agencies are on AIMS, they can condense all of their routes into a single connection and significantly reduce time and effort that would otherwise have to be dedicated to each.

In just over a month’s time, APHL worked with every single public health laboratory and agency to make sure they were able to electronically send their COVID-19 requests and results to CDC. They also worked on developing COVID-specific vocabulary and coding for testing so that when laboratories started conducting testing, they were all using the same terminology from the start. This means that all results sent to CDC were standardized—no effort or time had to be spent deciphering and comparing reports across laboratories to try and synthesize.

APHL’s job is to build and leverage technical solutions that will ease the burden on laboratories, not only for this response effort and a future of unknown threats, but to improve and simplify data exchange for public health at large on a day-to-day basis. When CDC launched its Data Modernization Initiative, it placed the urgent need for meaningful data to be sent and received faster; public health depends on information and results to be communicated quickly for surveillance, intervention and treatment. Time is critical. With the response to COVID-19, there is now a national recognition and comprehensive effort to modernize tools, technology, strategy and perceptions around data.

COVID-19 may very well prove to be a once-in-a-lifetime public health emergency. It may not. All we know is that we don’t know, and that our collective health and safety depends on having an efficient exchange mechanism in place to surveil, protect and be prepared.

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